Impact of stigma and discrimination on access to HIV services in Europe : monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia.
Date: 2017-06-26
Institutions: European Centre for Disease Prevention and Control
Subjects: AIDS, Central Asia, Europe, disease prevention, infectious disease, medical research, organisation of health care, public health, right to health, sexually transmitted disease, therapeutics

ECDC EVIDENCE BRIEF 

May 2017 

Impact of stigma and discrimination on access to 
HIV services in Europe 
Monitoring implementation of the Dublin Declaration on partnership to fight 
HIV/AIDS in Europe and Central Asia 

Key messages 

• 

• 

• 

• 

Two out of three countries in Europe and Central Asia acknowledge that 
stigma and discrimination within key affected populations is a barrier to the 
uptake of HIV prevention and testing services. 

Stigma and discrimination among health professionals, particularly with 
respect to sex workers, men who have sex with men and people who inject 
drugs, reportedly persists across the region and plays a role in preventing 
these key populations from accessing HIV prevention, testing and 
treatment. 

Many countries report that stigma and discrimination is a factor that 
contributes to late diagnosis of HIV. 

More needs to be done to reduce stigma and discrimination, both within 
affected communities and in healthcare settings. 

This evidence brief summarises information, reported to ECDC by government 
representatives in 48 countries for Dublin Declaration monitoring in 2016. It 
reviews the extent to which stigma and discrimination are perceived to affect 
access to and uptake of HIV prevention, testing and treatment services for key 
populations in the region and highlights priority options for action.  

It is important to note that there may be some differences in the way 
respondents have defined stigma and discrimination and that the Dublin 
Declaration monitoring did not ask respondents to provide detailed information, 
examples or evidence to support their responses. This brief therefore provides a 
broad overview of the situation rather than a systematic cross-country 
comparison or assessment of stigma and discrimination and their impact on HIV 
service delivery and uptake.  

It is also important to note that stigma and discrimination may also reflect and be 
reinforced by the legal and policy environment. The extent to which laws and 
policies affect access to and uptake of HIV services, based on Dublin Declaration 
monitoring, is discussed in a separate brief. 

Dublin 
Declaration 

This ECDC evidence 
brief summarises key 
issues related to the 
impact of stigma and 
discrimination on access 
to HIV services in 
Europe, focusing on the 
EU/EEA and identifying 
priority actions for 
improvement. It draws 
on 2016 Dublin 
Declaration monitoring 
data reported to ECDC 
by 48 countries. 

In 2004, under the 
leadership of the Irish 
Presidency of the EU 
Council, countries came 
together and adopted 
the Dublin Declaration 
on Partnership to Fight 
HIV/AIDS in Europe and 
Central Asia. Since 2009, 
ECDC has been 
responsible for 
monitoring its 
implementation. 

Suggested citation: European Centre for Disease Prevention and Control. Evidence brief: Impact of stigma and discrimination on 
access to HIV services in Europe. Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe 
and Central Asia. Stockholm: ECDC; 2017. 

© European Centre for Disease Prevention and Control, Stockholm, 2017 

 
 
 
 
 
 
 
 
 
 
ECDC EVIDENCE BRIEF 

Stigma and discrimination 

What are the main challenges? 

Stigma and discrimination within key populations limit uptake of HIV services. Many countries in the 
region report that stigma and discrimination within key populations represent a barrier to increasing the uptake of 
HIV services (Figure 1). Stigma and discrimination within key populations are more frequently reported as a barrier 
to increasing the uptake of prevention and testing services rather than a barrier to getting people diagnosed with 
HIV onto treatment.  

Over half of the reporting countries state that stigma and discrimination within the key population are a barrier to 
the uptake of prevention services for men who have sex with men (34/48 countries; 23 EU/EEA and 11 non-
EU/EEA), people who inject drugs (29/48; 18 EU/EEA and 11 non-EU/EEA), sex workers (29/48; 18 EU/EEA and 11 
non-EU/EEA) and prisoners (26/48; 17 EU/EEA and nine non-EU/EEA). A similar proportion of countries report that 
stigma and discrimination within the affected population represent a barrier to the uptake of testing services for 
the same key populations (Figure 1).  

Figure 1. Number of countries reporting stigma and discrimination within key populations is a barrier 
to uptake of HIV services, 2016 

Men who have sex with men

People who inject drugs

Sex workers

Prisoners

Migrants from high
prevalence countries

Undocumented migrants

Barrier to
increasing uptake
of HIV prevention
services

Barrier to
increasing uptake
of HIV testing
services

Barrier to getting
people diagnosed
with HIV on
treatment

0

10

20
Number of countries

30

40

Stigma and discrimination among health professionals also limits uptake of HIV prevention and 
testing services. Over half of the reporting countries state that stigma and discrimination among health 
professionals represent a barrier to the uptake of HIV prevention services by men who have sex with men (31 of 
48 countries; 18 EU/EEA and 13 non-EU/EEA), sex workers (29/48; 15 EU/EEA and 14 non-EU/EEA) and people 
who inject drugs (28/48; 16 EU/EEA and 12 non-EU/EEA) (Figure 2). A lower, but still significant number of 
countries reports that stigma and discrimination among health professionals represent a barrier to the uptake of 
HIV testing services for the same key populations (Figure 2).  

Figure 2. Number of countries reporting that stigma and discrimination among health workers 
represent a barrier to the uptake of HIV prevention and testing services 

Barrier to increasing uptake of HIV prevention services

Barrier to increasing uptake of HIV testing services

30

25

20

15

10

5

0

Men who have
sex with men

Sex workers

People who inject
drugs

Prisoners

Migrants from
high prevalence
countries

Undocumented
migrants

2 

 
 
 
 
 
 
 
 
 
ECDC EVIDENCE BRIEF 

Stigma and discrimination  

Stigma and discrimination are also reported to contribute to late diagnosis of HIV. Stigma and 
discrimination within key populations are more frequently reported as a factor in late diagnosis than stigma and 
discrimination among health professionals, although the number of countries reporting the latter is also high 
(Figure 3).  

Half of the countries in the region report that stigma and discrimination within key populations contribute to late 
diagnosis among men who have sex with men (31/48; 19 EU/EEA and 12 non-EU/EEA), people who inject drugs 
(25/48; 14 EU/EEA and 11 non-EU/EEA) and sex workers (24/48; 13 EU/EEA and 11 non-EU/EEA) (Figure 3). 

Figure 3. Number of countries reporting that stigma and discrimination contribute to late diagnosis 
of HIV, 2016 

Men who have sex with men

People who inject drugs

Sex workers

Prisoners

Migrants from high prevalence
countries

Undocumented migrants

Stigma and discrimination
within key populations

Stigma and discrimination
among health professionals

Stigma and discrimination
within key populations and
among health professionals

0

10

20

Nr of countries

30

Stigma and discrimination among health professionals may also limit provision of HIV services, in 
particular HIV prevention services, for key populations. A considerable proportion of countries in the region 
report that stigma and discrimination among health professionals represent a barrier to the provision of HIV 
prevention services for key populations – 65% of countries report this for men who have sex with men, 62% for 
people who inject drugs, 56% for sex workers and 48% for prisoners. A lower, but still significant, proportion of 
countries reports that stigma and discrimination among health professionals represent a barrier to the provision of 
HIV testing services for key populations – 50% of countries report this for men who have sex with men, 46% for 
sex workers, 42% for people who inject drugs and 31% for prisoners. A higher number of EU/EEA than non-
EU/EEA countries reported that stigma and discrimination among health professionals represent a barrier to the 
provision of HIV prevention and testing services across all key populations.  

Stigma and discrimination among health professionals also represents a barrier to getting people 
diagnosed with HIV onto treatment. Again, this affects certain key populations more than others, with 
countries most likely to report that stigma and discrimination among health professionals represent a barrier to 
getting people who inject drugs, men who have sex with men and sex workers onto treatment. Around one in four 
countries report this as a barrier for their key populations (Table 1). 

Table 1. Countries reporting that stigma and discrimination among health workers represent a 
barrier to getting people diagnosed with HIV onto treatment, 2016 

Percentage of countries   Number of countries 

People who inject drugs 

Men who have sex with men 

Sex workers 

Prisoners  

Undocumented migrants 

Migrants 

33% 

27%  

27%  

25%  

15%  

13%  

16  

13 

13 

12 

7 

6 

3 

 
 
 
 
 
 
 
 
 
 
 
 
ECDC EVIDENCE BRIEF 

Stigma and discrimination  

What needs to be done? 

The response from European and Central Asian countries indicates that stigma and discrimination within key 
populations and among health professionals are factors that limit efforts to increase the provision and uptake of 
HIV prevention and testing services in the region and to reduce late diagnosis of HIV. The impact is greatest for 
men who have sex with men, sex workers and people who inject drugs. These responses highlight the need for 
greater efforts to tackle stigma and discrimination, both within affected communities and in healthcare settings.  

Some countries did not respond to Dublin Declaration monitoring questions about stigma and discrimination; this 
may be because available data suggest that it is not a problem or because there are no data. In countries where 
the latter is the case it may be important to improve monitoring of the prevalence of stigma and discrimination 
within key populations and healthcare settings and monitoring of the impact of stigma and discrimination on the 
provision and uptake of HIV services for key populations.  

Priority options for action 

• 

Improve evidence showing the extent and nature of stigma and discrimination among key populations and 
health professionals and the way in which this affects the provision and uptake of HIV prevention and testing 
services. 

•  Develop and implement more effective approaches to eliminate stigma and discrimination towards key 

populations, particularly within healthcare settings. 

•  Collaborate with and support community organisations to develop and implement more effective approaches to 
reducing stigma and discrimination within key populations, including self-stigma, and to support individuals in 
challenging stigma and discrimination.  

Stockholm, May 2017 

ISBN 978-92-9498-067-0 

doi 10.2900/464011 

Catalogue number TQ-02-17-603-EN-N 

© European Centre for Disease Prevention and Control, 2017 

Reproduction is authorised, provided the source is acknowledged 

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